February 2007 | Volume 9 | No. 4

Policy & Legislation

Elder Justice Watch

Elder justice is still a story in the making, and advocates are pressing on. While action is progressing at a slower pace than expected as some details are still being worked out, in the long run, according to Elder Justice Coalition reports, introduction of a Senate bill is expected as well as a companion bill introduced in the House.

The Elder Justice Coalition serves as the primary point-of-contact with Congress for elder justice issues. For updates, call (202) 782-4140 or e-mail elderjustice@verizon.net. More information >> www.elderjusticecoalition.com/

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Congress Approves Fiscal 2007 Spending

Earlier this month, Congress reached agreement on federal spending for the balance of fiscal 2007, which ends September 30. For most agencies, funding is set at the 2006 level.

Older Americans Act and SSBG Highlights

  FY '07
Final CR
FY '06
Final Enacted
FY '07
President's Request
FY '08
President's Request
Older Americans Act
OAA Title VII Vulnerable Elder Rights Protection
20.1 million 20.1 million 19.2 million 19.2 million
Social Services Block Grant
(Major source of federal funding for Adult Protective Services)
1.7 billion 1.7 billion 1.2 billion 1.2 billion

Obviously, there are many important and competing priorities for discretionary spending. To learn more about the Office of Management & Budget's performance rating of the Social Services Block Grant (SSBG), see www.whitehouse.gov/omb/expectmore/detail/10003503.2005.html

2007 Continuing Appropriations Resolution

SSBG State Allocations

2008 Budget Proposals

A January article about the new Congress incorrectly identified Senator Gordon Smith of Oregon. Senator Smith is the former chair and ranking Republican of the Senate Special Committee on Aging.

State News: Legislative Watch

The 2007 state legislative season has begun. For those interested in tracking trends, the following highlights some of the bills that have been proposed. We will continue to report new developments in coming months.

SB 1184
An Act relating to adult protective services; vulnerable elders
Among other things, seeks to extend protections to persons between 18 and 74 years of age if they meet the definition of "vulnerable adult"; add definition of "Elder" to extend protections to persons 75 years or older; and permit the Department of Human Services to investigate and the court to have jurisdiction when reason exists to believe that an elder or vulnerable adult has been abused or is threatened with imminent abuse.

AB 58
An Act relating to crimes
Would classify as first degree murder any murder committed in connection with elder or vulnerable adult abuse or neglect.

AB 68
An Act relating to nursing home/institutional care
Would expand grounds for which the state can deny, suspend, or revoke a license to include abuse, neglect, exploitation, or isolation of older persons or vulnerable persons. Similarly, expands grounds for which termination of an employee or independent contractor is required.

AB 87
An Act relating to mandatory reporting
With certain exceptions, any officer or employee of a financial institution who has direct contact with an older person or who reviews or approves their financial documents, records, or transactions would be required to report suspected abuse or exploitation.

SB 31
An Act relating to records of criminal history
Would add Nevada Aging Services Division to the list of those authorized to request, receive, and review criminal history records held by law enforcement.

South Dakota
SB 193
An Act to prohibit the abuse of certain elderly persons and to revise certain provisions regarding the abuse of disabled adults
Among other things would add a new section clarifying and qualifying the term neglect in relation to decisions not to seek medical care.

In Focus: Nursing Homes & Victims' Advocacy

An Obligation to Those in Need

Cheryl Wilson, ombudsman victim advocate and director of SERVE (Serving Elderly Residents Who Are Victims of Crime) in St. Louis says families and communities need to be vigilant against abuse in nursing homes.

"I think the community needs to know what is going on," Wilson says, adding that victims and survivors desperately need our help.

SERVE, a victim advocacy initiative of the Long Term Care Ombudsman Program of St. Louis, Missouri, was established in 1996 with a Victims of Crime Act (VOCA) grant to provide elder abuse crisis counseling, crime victim advocacy, criminal justice support, and a much-needed voice for nursing home residents who have been abused by staff or others, including family.

The SERVE team of six ombudsmen (four trained volunteers and two staff) handles 35 to 40 cases a year. Referrals come from the state hotline, law enforcement, nursing homes, hospitals, family, and in some cases residents themselves.

"We cover all types of abuse, [ranging from] physical, psychological, verbal, sexual, to financial," says Wilson. "Once an allegation is made, we go to the facility and meet with the victim and try to assess for trauma."

During the initial contact, charge nurses and key staff are interviewed, and calls are made to family. The purpose is not to investigate the crime, but to identify any needs the resident may have as a result of the abuse.

At the top of the action list to reduce trauma, prevent re-victimization, and also prevent similar crimes from occurring is removing the alleged perpetrator from having further direct contact with the victim, Wilson says.

The Department of Health and Senior Services' Section of Long-Term Care Regulation is charged with conducting the actual investigations.

Victims Want to Tell Their Stories
Over 75 percent of the victims SERVE has helped have some form of dementia. "In the majority of cases," Wilson says, "the resident is unable to tell what happened." But if you really listen, observe body language, voice tone and facial expressions, and ask good questions, you can pick up hints and clues, she says.

She gave this example. A resident repeatedly voiced she was tired of being married. Knowing that she had never been married, Wilson was able to gently ask about her "husband." Her answer provided Wilson with an important first clue. She said simply, "I don't like him coming in my room and being with me."

Crimes Notoriously Difficult to Prove
Wilson says the problem in most cases, especially those involving dementia, is that the victim can't say 'I did not want this.'

"In the court system, if you can't say that, it goes to a whole new level [in terms of proof], a much lower level for the perpetrator," she says.

In ten years SERVE has advocated for over 400 patients. Three cases ended up in court, all for sexual assault.

One case, Wilson says, really sticks out. A male nurse was found in bed on top of a resident with mid to late stage Alzheimer's disease. The defendant's explanation was "she wanted it." Adding insult to injury, it was also claimed that because of Alzheimer's patients' reduced ability to feel pain, a person with Alzheimer's cannot suffer trauma.

The victim's inability to testify "made it difficult for the court," Wilson says. The outcome: the judgment in this case was a suspended license and a sentence of five years probation.

Building a Stronger, Caring Community
SERVE is a unique model worth watching, as it is one of only a few ombudsman programs that offer crime victim advocacy. Wilson says the community's feedback to the program, which is just now entering its second decade, has been very positive. It continues to receive VOCA victim assistance funding.

"There needs to be a lot more of these programs," she says. "Every nursing home has the potential for this. The ombudsman is just a natural to take this on."

Cheryl Wilson welcomes questions. You can reach her at cjwilson@ltcop-stl.org

More Information

"The forms of elder abuse found in nursing homes mirror those found in domestic settings; they include homicide, physical and sexual assault, neglect, inappropriate restraint, financial abuse, isolation, verbal threats and intimidation. In addition, nursing home abuse includes institutionalized practices that result in chronic neglect, sub-standard care, overcrowding, authoritarian practices, and failure to protect residents against untrained, troubled or predatory workers, or against abusive residents or visitors."
– Lisa Nerenberg, MSW, MPH, Abuse in Nursing Homes,
National Center on Elder Abuse

Communicating with Someone with Dementia

Things That Work

  • Be patient and supportive. Let the person know you are listening and trying to understand what is being said.
  • Show interest. Keep good eye contact. Show you care about what is being said.
  • Give the person time. Let them think about and describe whatever they want to. Be careful not to interrupt.
  • Offer a guess. If the person uses the wrong word or cannot find a word, try guessing the right one.
  • Encourage unspoken communication. If you don't understand what is being said, ask the person to point or gesture.
  • Focus on the feelings, not the facts. Sometimes the emotions being expressed are more important than what is being said.
  • Call the person by name.
  • Talk slowly and clearly. Use short, simple words and sentences.
  • Ask one question at a time. If the person doesn't respond, wait a moment. Then ask again.
Things That Don't Work
  • Do not become defensive.
  • Do not ask questions that require explanations, especially "why" questions.
  • Do not belittle or talk down to a demented adult; do not treat him or her like a child.
  • Do not quiz a person with memory loss. Avoid asking, "Do you remember when...?"
  • Do not disagree, criticize, correct, or argue.

Sources: Alzheimer's Association www.alz.org and Alzheimer's Disease Resource Agency of Alaska www.alzalaska.org

NCEA News & Resources

Behind the Scenes: NCEA Staff Keep Valuable Information Flowing

  NCEA Elder Abuse Newsfeed
One of the direct benefits of joining the NCEA Elder Abuse Listserve is the daily Newsfeed, which provides breaking news stories on elder abuse gathered from small and large sources, local and regional news outlets, and renowned newspapers such as the Wall Street Journal and New York Times.

NCEA Newsfeed manager Anne Kincaid of the National Adult Protective Services Association culls through hundreds of daily and breaking news stories to bring you the most important news you need to know. Members of the NCEA Elder Abuse Listserve receive this valuable digest each day. We've gotten great feedback from you, as in the examples below.

"A week or so ago I did some presentations with a group of doctors….To put a personal face on the abstract idea, I printed out and distributed a week's worth of newsfeeds, and highlighted a few of them in my talk. Watching their jaws drop and the light bulbs go on really demonstrated that they were "getting it" about what might be going on with some of their patients. This was a direct result of the work that you're doing."

"It not only keeps me aware of what is going on…around the world regarding elder issues, but it provides information from other states on areas that my state is addressing…."

In addition, some Adult Protective Services programs have used the daily newsfeeds as a tool for staff and allied professional development.

Looking at trends, Anne says her impression is there's far more coverage of elder abuse topics and stories than there were three years ago.

"When one google searches the term elderly, not many happy stories come up," she says. "I am seeing a lot of assault cases that include charges of elder abuse. From missing dementia patients to grandmothers being neglected by their family, it is usually a story about an elderly person being hurt in some way. Financial abuse of the elderly seems to come up the most often, I believe."

Anne also says she's noticed that human interest features, such as the legal dispute over 104-year old New York philanthropist Brooke Astor's care, can have a real snowball effect. Many smaller publications picked up on that case and profiled similar local situations.

"I would hope that, in some small way, the Newsfeed may help spread a little awareness about elder abuse issues," she says.

  NCEA Promising Practices Database
Designed to help state and local program staff avoid reinventing the wheel, the NCEA Promising Practices Database contains brief descriptions of 400+ initiatives operating across the United States and in Canada.

Starting with a broad sweep four years ago, NCEA Program Associate Suzanne Stack of the National Association of State Units on Aging gathers information about emerging and promising practices from a plethora of sources, including the NCEA Elder Abuse Listserve, state and local elder rights contacts, and published reports, referrals, and news stories.

"Persistence is an important part of this job," Suzanne says. "The key contacts, people who know most about how the project started, what funding is used, and have advice for others are busy people. I track them down, talk with them individually on the phone, and develop brief descriptors which they review before the program is profiled on the NCEA Web site. I try to make it as easy as possible for them to include their initiative in the national database."

A great strength of the service is the large variety of initiatives profiled. A total of 58 topic areas are covered, ranging from abuse registries to emergency shelters, guardianship, and undue influence.

"We provide enough information for professionals to get the gist of what is going on and information on how to follow up if they need more," she says.

As to the practices themselves, what's been most striking to Suzanne is "the generosity and willingness of contacts and project developers to spread out their experience by providing advice and suggestions to others."

We thank all who have shared their ideas.

  Clearinghouse on Abuse and Neglect of the Elderly (CANE)
Housed at the University of Delaware, CANE offers a virtual goldmine of information for those looking for research and scholarship on elder abuse and neglect and the conditions that impact on elder mistreatment.

CANE Research/Information Specialist Sharon Merriman-Nai, a key member of the NCEA team, has a strong personal commitment and vision "to shine a light on societal issues, such as ageism, that contribute to conditions that marginalize older individuals and therefore may allow elder mistreatment to proliferate."

CANE's loyal patrons come from all walks of life, including aging services, social services, health care, law enforcement and the legal arena, education and research, public policy, the media, students, families, friends, and elders themselves.

People in the field depend on information. To push out knowledge, Sharon monitors numerous databases and publications, and continue to add to the CANE database, highlighting online new publications that speak to timely topics.

To keep track of trends arising in the field, Sharon routinely monitors the "conversation" of the Elder Abuse Listserve and NCEA Newsfeed. "We attempt to identify themes that are prominent in these arenas, and to select topics for the CANE Bibliography Series that will speak to these subjects from a variety of perspectives," she says.

Sharon also has a unique vantage on the trends in scholarship. "Multidisciplinary" appears to be a unifying watchword.

"Recently, I'm seeing more references among law enforcement and criminal justice publications, and business and banking oriented sources, but publications featuring elder mistreatment are literally popping up everywhere. Also, there are many more online resources, including training curricula and toolboxes which are freely accessible," Sharon says.

Research & Scholarship

  "The Clinical Presentation of Elder Neglect: What We Know and
What We Can Do"
by Sheryl M. Strasser ss3902@nyu.edu and Terry Fulmer, New York University, College of Nursing
Journal of the American Psychiatric Nurses Association, Volume 12, No. 6 / January 2007

"Elder neglect (EN), one of the most prevalent forms of elder mistreatment, has clear mental health implications that may play a crucial role in the detection and intervention of elder neglect. Increased awareness of the clinical and psychological manifestations of EN, as well as understanding recommended assessment and interventional strategies, may help psychiatric nurses who may be on the frontline of EN identification prevent the escalation of neglect into more severe cases of elder abuse."

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Editor's Note: Scholarly literature is often published online before print publication. Check individual publisher sites for full-text availability. Many publishers offer pay-per-article service.

To see abstracts of more published studies, visit the Clearinghouse on Abuse and Neglect of the Elderly at http://db.rdms.udel.edu:8080/CANE. For help in obtaining references, e-mail CANE at CANE-UD@udel.edu.

Funding Opportunities

"No Private Matter! Ending Abuse in Intimate & Family Relations,"
Changemakers and Robert Wood Johnson Foundation Collaborative Competition

"No Private Matter! Ending Abuse in Intimate & Family Relations," a collaborative competition co-sponsored by Changemakers and the Robert Wood Johnson Foundation, is seeking innovative approaches and solutions from the field to help eliminate intimate partner violence.

Entries are invited from organizations in all countries. All entries must be beyond the stage of idea, concept, or research, and, at a minimum, be at a demonstration stage and indicate success.

Changemakers is an initiative of Ashoka a global association of leading social entrepreneurs dedicated to creating positive social change.

The Collaborative Competition will include a cash prize of US $5,000 for the top three winners.

Deadline: March 28, 2007

More info

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Resources for Grant Writers

Distance Learning/Professional Development

CBS News Reports: A Jumping-Off Point to Talk About Solutions

A recent CBS Evening News series on elder abuse, which aired last fall, may be useful as a jumping-off point for talking about solutions. Take a look. The broadcasts are available online for no charge.

"Uncovering Elder Abuse" – Kelly Cobiella, CBS News Correspondent
Original Air Date: Nov. 14, 2006

Click to view >> www.cbsnews.com/sections/i_video/main500251.shtml?id=2182246n
(Running time: 2:44)

"Aging in the Shadows" – Armen Keteyian, CBS News Correspondent
Original Air Date: Nov. 14, 2006

Click to view >> www.cbsnews.com/stories/2006/11/13/notebook/main2176924.shtml
(Running time: 3:15)

Calendar/Coming Up

4th Biennial National Conference on Health and Domestic Violence

March 16-17th 2007
Marriott San Francisco
San Francisco, California

Sponsored by the Family Violence Prevention Fund, University of California, San Francisco, and National Center of Excellence in Women's Health

More info >> www.fvpfhealthconference.org/

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2007 National Crime Victims' Rights Week

The Office of Victims for Crime (OVC) invites you to help observe National Crime Victims' Rights Week, April 22-28th 2007. This year's theme is "Victims' Rights: Every Victim, Every Time." The Office for Victims of Crime Web site has a 2007 NCVRW resource guide (with sample speeches, camera-ready art, and quick tips for planning), posters, DVD clip, and upcoming events.

More info >> www.ovc.gov/ncvrw/welcome.html

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"Day to End Sexual Violence"

Thursday, April 5th 2007

Sponsored by the National Sexual Violence Resource Center, A project of the Pennsylvania Coalition Against Rape, the oldest and one of the largest state sexual assault coalitions.

More info >> www.nsvrc.org/saam

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Check our Web site often for more dates and events elderabusecenter.org/default.cfm?p=conferencesevents.cfm

NCEA Newsletter

is published 10 times a year by


February 2007
Volume 9, No. 4
Sara Aravanis, Director
Susan Coombs Ficke, Contributing Writer/Editor

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The NCEA Newsletter is supported in part by a grant, No. 90-AM-2792, from the U.S. Administration on Aging, Department of Health and Human Services.

Points of view or opinions expressed in this publication do not necessarily represent the official views of AoA/HHS or any of the NCEA's affiliated partners.

NCEA always welcomes news from the field. Please direct comments and suggestions to the editor, Susan Coombs Ficke sficke@nasua.org


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NCEA News Archives on the Internet >>

Sign up today for the National Center on Elder Abuse Listserve

NCEA Elder Abuse listserve provides a free, 24-hour, 7-day-a-week online link to others who are working on elder abuse issues. The NCEA listserve is a discussion forum for professionals working in elder abuse or allied fields. Membership is restricted to adult protective services practitioners and administrators, aging services practitioners and administrators, educators, health professionals, judges, lawyers, law enforcement officers, prosecutors, policy makers, and researchers.

To request a subscription to the Elder Abuse listserve, just fill out the form at www.elderabusecenter.org/default.cfm?p=listservesubscribeform.cfm. If you don't have access to the Web-based form, you can instead e-mail the list manager at lstiegel@staff.abanet.org; you must provide the following information:

  • Your name, profession, and e-mail address
  • A statement of your interest or expertise in elder abuse or adult protective services
  • Employer's name (if applicable) and address
  • Phone number (so that you can be contacted in the event of an e-mail problem)

See our Web site for more details.